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1 First Edition Design & Refine Developing effective interventions for children and young people The Social Research Unit at Dartington

2 Table of Contents Acknowledgements 1 Introduction 2 1 The what works standards of evidence 6 2 Designing your intervention: How to improve intervention specificity What is intervention specificity Improving intervention specificity 13 3 Planning for implementation: How to improve system readiness What is system readiness improving system readiness 22 Glossary 31 Copyright 34

3 Acknowledgements The Social Research Unit at Dartington is an independent charity that seeks to increase the use of evidence of what works in designing and delivering services for children and their families. We are also a strong advocate of prevention and early intervention approaches. We have over 50 years experience of researching what works in improving children s outcomes across the education, health, social care and youth justice systems. This guide has been produced as part of the Realising Ambition project, a 25m Big Lottery Fund programme intended to take a preventative approach to youth offending by improving outcomes for children and young people aged It seeks to do this by replicating evidence-based interventions that are proven to reduce youth offending, and by supporting charities to refine and evaluate promising interventions those not yet proven to work but excellent candidates to become evidence-based interventions. The Social Research Unit is part of a consortium delivering the programme, alongside Catch 22, the Young Foundation and Substance. Its role includes evaluating the impact of the programme as a whole and supporting the portfolio of 25 charities being funded as part of the programme to refine and develop their intervention and evaluate their impact. For more information visit The guide has been written by Nick Axford, Vashti Berry, Sarah Blower, Michael Little, Tim Hobbs and Sonia Sodha. Together we have extensive first-hand experience of working with managers and practitioners in children s services in Europe and the US to develop, implement and evaluate evidence-based interventions. We are very grateful to colleagues for helpful comments on an earlier draft, in particular Louise Morpeth (SRU), Lynette Basha (Oxford Brookes University), Angela Gentile (YMCA Scotland), Lindsey Higgins (Winston s Wish) and Sam Pashley (Trelya). Thanks are also due to Beth Truesdale for editing and to colleagues at Dartington for their assistance with the guide, especially Daniel Ellis, The Social Research Unit offices at Dartington Rebeca Sandu and Laura Whybra. 1

4 Introduction

5 Introduction is trying to reduce youth crime, are they better off spending money on interventions If you work in an organisation delivering interventions that aim to improve This is why the Social Research Unit at Dartington together with our international outcomes for children and young people, then this guide is for you. It is designed to partners developed a set of clear, transparent what works standards of evidence help you think about how to strengthen the impact of what you do to improve to determine a list of interventions that are well-designed, proven to improve child children s lives, and focuses on designing an intervention and planning for its outcomes and ready for implementation. These standards are aimed at a range of implementation, both of which are crucial to maximising the potential impact of any different people involved in funding, commissioning, designing and delivering intervention. A future publication from the Social Research Unit at Dartington will children s services: that say they improve young people s behaviour or their school results? look at how to design, implement and use the results of evaluation also key to being able to improve the impact of what you do. For local commissioners, when applied to a field of interventions, the standards can be used to generate a list of tried and tested approaches to In the last decade, there has been increasing interest from government, commissioners and funders in understanding what works in improving children s inform commissioning at the local level. For charities and other organisations that work with children who are outcomes and in funding those interventions that have a proven impact on children s committed to increasing the impact of their work, the standards represent a set outcomes. If anything, the tough fiscal climate all public bodies are now operating of criteria that they can use to assess their own work and move towards over under has augmented this interest, as commissioners seek to understand which the long-term through the design, refinement and evaluation of what they do. services provide the best value for money in terms of the outcomes they achieve. For trusts and foundations that fund organisations working with children and young people and want to support those organisations to increase the impact That of course leads straight to the question how can we tell what works? This of their work, the standards can be used to inform how they invest in seems like a simple question at first, but when decision-makers try to apply it to the evaluation and can also help them think about how to achieve impact from field of potential interventions they could theoretically spend money on, it quickly their own grant-making strategies. becomes very complex. How do you tell if there is evidence whether an intervention does what it claims to do? How do you compare and contrast the very different types of evidence that may be presented to support these claims? If a decision maker 3

6 The standards of evidence focus on four key dimensions, which are outlined in more children s outcomes across the education, health, youth justice, education and social detail in Chapter 1: care systems. As part of this project, reviewers examine all the available international Intervention specificity This relates to the design of an intervention. Is it evidence on different interventions to see which ones meet the Blueprints standards focused, practical, logical and designed using the best available evidence of evidence. There is a rigorous, independent process for determining which about what types of factors affect child outcomes and what works in interventions meet the standards, including an independent board of international improving outcomes? experts in evidence-based prevention and early intervention that meets twice a year System readiness This relates to the way in which an intervention is to review programmes. implemented. Is there enough information and resources that come with an intervention like manuals, training material and implementation The standards represent a very demanding test, and it is most appropriate to apply procedures so that it can be rolled out within public service systems, them to interventions where there are already results from a robust impact like the education, health, youth justice and social care systems? Is there evaluation that uses a control group. But we believe the standards also help sufficient information about what financial and human resources are organisations who have not yet robustly tested their work using experimental needed to deliver an intervention? evaluation to think about how they can improve the impact of their work and to get Evaluation quality Are the impact evaluation/evaluations of an their interventions ready to be experimentally evaluated. We can think of a pipeline intervention robust enough in their design and execution to give us that spans innovations to interventions with proven impact. It is only through well- confidence in the results? This dimension hinges on the premise that in designed, logical and evidenced innovation that we can test what works in social science impact evaluation requires a control group to compare the improving children s outcomes, and refine and improve the impact of those effect of getting the intervention versus not getting the intervention. interventions already proven to work. To move along the pipeline, organisations can Impact What do robust evaluations tell us about how much impact the benefit from thinking about how all four dimensions of the standards apply to their intervention has on key developmental outcomes for children those own work, for example: outcomes that really matter in terms of children s future life chances?! How their intervention is designed and refined. What needs to be done to get it ready to be implemented within public service The Social Research Unit at Dartington is a collaborator on Blueprints for Healthy Youth Development, a project with the University of Colorado at Boulder to apply a systems. How to design, carry out and use the results from impact evaluations. version of these standards to the field of interventions designed to improve 4

7 In an ideal world, organisations would bear the standards in mind when designing a A standards of evidence self-rating app. This will shortly be available on new intervention from scratch. So, you might start off with how to design an our website ( and will allow charities and other intervention, then think about implementation, then carry out evaluation and, organisations to self-assess their interventions against our standards of depending on the results of that, go back to refine your original intervention and so evidence. on, in an iterative improvement cycle. A series of webinars for the portfolio of youth charities being funded as part of the Big Lottery Fund s Realising Ambition project, available online at Of course, in the real world, many organisations are already delivering an These webinars intervention to a large group of children and come to the standards of evidence at cover much of the material in this guide and may be a useful further the point they are starting to think about evaluation. But then the standards offer an resource. opportunity to step back and think about how your intervention is designed and implemented and whether there are refinements you would want to make before subjecting it to a robust evaluation to give it the best possible chance of success. The rest of this guide is structured as follows: Chapter 1 outlines our what works standards of evidence in more detail. Chapter 2 describes the intervention specificity dimension of the standards This guide is focused on supporting organisations in thinking about how to meet the in more detail, and sets out practical steps for what you should consider first two standards intervention specificity (focusing on the design and refinement when you are in the process of designing and/or refining your intervention. stages) and system readiness (focused on implementation, and the resources that Chapter 3 describes the public service system readiness dimension of the would enable an intervention to be implemented within public service systems). We standards in more detail, and sets out practical steps for what you should will be producing another guide that focuses on the third and fourth dimensions of consider when you are in the process of making your intervention deliverable the standards, which concern evaluation and the measurement of impact. within the education, health, social care or youth justice systems. The Glossary sets out some of the technical terms used in this guide. Other resources we are producing at the Social Research Unit at Dartington that complement this guide and may be of interest include: A guide to the standards of evidence, explaining each standard in more depth. This will shortly be available on our website ( 5

8 The what works standards of evidence 1

9 Chapter 1 The what works standards of evidence These standards of evidence set out some clear criteria that help us to understand the extent to which an intervention designed to improve the outcomes that matter for child development has the potential to improve children s lives. This chapter describes in more detail the criteria we use to judge the extent to which an intervention meets each standard. 1. Is the intervention focused, practical, logical and based on the best available evidence? We have standards in many walks of life standards of hygiene in restaurants, standards of quality in manufacturing, standards of proficiency for professionals. People or organisations meeting the standards are known to be sound or good. Equally, these standards serve as a guide to others who aspire to reach that level of quality. This chapter describes the standards There have been a large number of quality evaluations examining how much impact different interventions have on children s lives. These studies do not tell us precisely what to do. But they do reveal features that are shared by successful interventions. we have developed to assess interventions designed to improve child outcomes to help with Put plainly, interventions that are successful in improving child well-being are identifying the best today, and to help those who wish to be the best tomorrow. specific about whom they are trying to reach, what they are trying to achieve, what The Social Research Unit at Dartington s what works standards of evidence revolve around four questions. As outlined in the Introduction, they are related to determining if an intervention has an effect positive or negative on relevant outcomes and whether it is feasible to implement that intervention in a public service system. The four questions are: 1. Is the intervention focused, practical, logical and designed based on the best available evidence? We call this intervention specificity. 2. Can the intervention be implemented in the real world context of a public service system? We call this system readiness. they actually consist of (what is delivered) and the rationale underpinning the intervention whether its theory of change is based on the best-available evidence about what factors impact on child outcomes and what works in improving those outcomes. The question is the intervention focused, practical and logical? can be asked before any evaluation of impact on children s lives takes place. In fact, people commissioning, developing and providing new interventions should consider these issues during the design phase. 2. Can the intervention be implemented in the real world context of a public service system? 3. Is the evaluation design and execution robust enough to permit confidence in the results? We call this evaluation quality. Some interventions have been proven to improve the well-being of children and young people, but few have been implemented at scale. Even the best-known 4. What do robust evaluations tell us about how much impact the intervention has on key developmental outcomes for children? We call this impact.! evidence-based interventions are not widely implemented. An important reason for this is that although interventions are often designed to be delivered through 7

10 education, youth justice, mental health or social care systems, few have succeeded in else. The standards therefore require there to be information about the financial and becoming core to a system. Many children who would benefit from these human resources required to deliver the intervention. interventions therefore miss out. As a result, evidence-based interventions are some way from realising their full potential. Only a tiny proportion of children benefit from evidence-based interventions, and for many who do it is as subjects in 3. Is the evaluation design and execution robust enough to permit confidence in the results? evaluation trials. What can be done? Lots of evaluations are commissioned to estimate the impact of interventions on In order for interventions to be delivered at scale, interventions have to be made children s lives. But studies often leave people unsure about whether or not the ready for public service systems. The standards are designed to help find out to what intervention is effective. This is partly because many commissioners of evaluations extent an intervention is system ready. Are the information and resources that are hazy about what makes for high-quality impact evaluation. would enable its successful implementation in a system readily available? Or, put another way, would a decision-maker interested in implementing the intervention in The standards value evaluations that use a comparison or control group, meaning question know what was needed to do this and where to get that information? Being that the progress of children experiencing the intervention is compared with that of system ready mean fitting seamlessly into a school curriculum or harmonising with another group of children not receiving that intervention. If the children in the the work of highly skilled practitioners, for example. intervention and control groups are assigned to these conditions at random, in a randomised controlled trial (RCT), it helps increase confidence that differences Since it is now established that when interventions are delivered with what is called observed in outcomes as the trial develops are due to the intervention and not pre- fidelity meaning they are implemented as intended by their designers they existing differences between the children in different groups. achieve the best results, resources and activities that promote fidelity are included in the standards. These include manuals, training materials, implementation The standards also pay attention to the tools used to monitor key developmental procedures, technical support and fidelity protocols or checklists. outcomes, the way in which the data are analysed, the number of participants (children, families, schools and so on) that drop out of the evaluation, and other By definition, interventions can only succeed if they are used. They need to engage important methodological issues. children and families, and children and families need to find interventions easy to access. Too often this is not the case. Methods to engage children and families are 4. What do robust evaluations tell us about how much impact the therefore increasingly common traits of evidence-based interventions, and the intervention has on key developmental outcomes for children? standards encourage evidence of explicit processes for ensuring that the intervention gets to the right people. The bottom line of any outcome evaluation is how much difference the intervention makes to children s lives, and whether the difference is positive or negative. We call Lastly, decision-makers need to know how much interventions are going to cost, and this impact. The standards require clear evidence of a positive impact of the who is needed to deliver the interventions. This information is often so hard to intervention on child outcomes of interest and no evidence of a harmful effect. obtain that commissioners give up in frustration and decide to implement something 8

11 Intervention impact has been measured in several ways. Researchers sometimes talk about the odds of better outcomes for children receiving an intervention compared with those not receiving the intervention. Some evaluations compare the prevalence or proportion of those in each group who engage in a specific behaviour like smoking or who achieve a specific outcome like going to university. Some evaluations refer to moving children from, say, the 50th to the 60th percentile on a given outcome. The standards encourage more widespread use of a way of measuring impact known as effect size. Effect size is increasingly used in good evaluations and, with some important caveats, permits like-with-like comparisons of intervention impact across geography and service sectors. An added advantage of effect size is that it is used in cost-benefit analysis, which translates impact on child outcomes into monetary terms. It is expected that cost-benefit data will increasingly be required as decisionmakers seek to make the best use of scarce resources. 9

13 Chapter 2: Section 1 What is intervention specificity? There are three key aspects to intervention specificity: 1. What the intervention is 2. What the intervention tries to achieve, and for whom 3. How the intervention is supposed to work 1. What the intervention is There is clarity and documentation about what the intervention comprises Successful interventions are clear about what they are, what they aim to achieve, and how they aim to do it. So the first dimension of the standards is concerned with whether an intervention is focused, practical and logical. This chapter describes the criteria used in the standards of evidence to assess intervention specificity and then looks at how it can be improved for a given intervention. It can be surprisingly difficult to establish what an intervention actually is. The people who are most familiar with it tend to know intuitively what it is but they often struggle to explain it simply to others. This is not necessarily a problem for a small, local intervention, although when you delve deeper it is common to find that different people involved in delivering the intervention have different In the design phase, an intervention will most likely be delivered by the people understandings of what it is they delivering. But when designers seek to replicate the who developed it. But if the intervention is to have a lasting and widespread intervention or increase its scope, clarity about what the intervention comprises is impact on children s health and development, it will need to be delivered by essential for success. people who know next to nothing about how the intervention was first assembled. Future providers, practitioners and, in some cases, children and families will need Clarity about the intervention involves stating what is provided, by whom, over to know what the intervention comprises, why it has been designed as it has, what what period, for how long, with what frequency, where and how. Put another way, is the logic behind it, what aspects are essential to its success, and what aspects are you need to spell out: content (e.g. information, advice, training, money, advocacy); adaptable. It may be necessary to document the skills and procedures upon which provider (e.g. social worker, teacher, psychologist, volunteer); duration (e.g. 3 hours, success depends. But it is as important to express the spirit with which the 6 weeks, a school year); length of inputs (e.g. 2 hours); frequency of inputs (e.g. daily, intervention was designed, setting out why there was a need, what is different and weekly, monthly); setting for delivery (e.g. school, health clinic); and mode of the driving force behind its creation. delivery (e.g. group-based, one-to-one). 11

14 2. What the intervention tries to achieve, and for whom 3. How the intervention is supposed to work The outcomes of the intervention are relevant and clearly specified There is a clear, logical theory of change explaining why the intervention will lead There are sadly no silver bullets in the world of improving child outcomes. Effective to better outcomes interventions designed to improve child outcomes tackle one or two or at most three Good innovation is underpinned by a simple, clear and logical theory of change a or four outcomes at a time. They do not try to solve all ills. It is therefore worth description of why the intervention is expected to achieve the desired outcomes with reflecting on the aspect of health or development that an intervention is designed to the target population. Usually, this will involve spelling out the chain of effects that impact on, for example emotional health, intellectual development or behaviour. result in improved outcomes. For example an intervention might be designed to There may be broader benefits to the child if the targeted outcome is improved. reduce the risk of living overcrowded housing to a child s educational outcomes. Or Precision is necessary. It should be possible from previous research to establish how much progress is possible for the target group, and over what period, and in setting these goals to be aspirant but realistic, not over-promising. It is helpful to say how it might try to boost the protection offered by a signifiant adult to offset the risk of poor parenting to a child s behaviour. Or it might try to boost a child s resilience to adversity, for example by helping children to manage stress. such decisions were arrived at in other words, to show your working out. For Again, precision is essential. It should be possible to use evidence to quantify how example, suppose you are trying to reduce alcohol consumption. You find that other much change to risk, protective factors or resilience is anticipated. interventions have managed to do this by 30%. However, they have been more intensive and with heavy drinkers only. Your intervention is lighter touch and There is a research base that supports the theory of change targeted at a wider group. You might conclude it is reasonable to expect your The evidence should be set out at each stage in the specification of the intervention. intervention to have a weaker effect perhaps achieving a 10% reduction. The target population should be quantified using local population statistics and The intended population of focus is clearly defined epidemiological data. The amount of improvement in outcomes should be estimated using reviews of similar endeavours as a guide. The risk and protective factors that Effective interventions are selective about who is being helped with what. It should the innovation seeks to affect should be linked to research showing how they connect be clear which stage of children s development is being targeted, and whether the to the outcomes. An estimation of the intervention s potential impact should be intervention is going to reach all children of a particular age group, or a selected supported by existing research on how the outcomes in question can be improved. group for example, those at risk of developing mental health problems or those Confidence in the intervention s potential impact will reflect the quality of the displaying certain risk factors. It should be obvious if the intervention is seeking to underpinning evidence. prevent problems from occurring or get in early when the first signs of difficulty appear, or treat fully-established problems. If there are reasons why certain children or families might be excluded from receiving the intervention for example, because of their age or the nature of their difficulties this should be stated as well. 12

15 Chapter 2: Section 2 Improving intervention specificity The second is at what stage of a problem you want to intervene. Roughly speaking, do you want to prevent a problem from occurring, to intervene early in its development, or to promote the best possible recovery or at least minimise harm after a problem has occurred? For instance, if your concern is child anti-social behaviour, you might want to improve parenting skills to decrease the risk of poor behaviour, or intervene with counselling when the first signs of misbehaviour appear, or change the way that schools respond to children who have a conduct disorder. To use more technical terms, you need to think whether you are interested in prevention stopping the problem happening in the first place; early intervention getting in at the first signs of trouble; or treatment responding once something Improving intervention specificity requires asking five questions about an has gone wrong. intervention: An example of a preventative intervention is the PATHS programme, a social and 1. Who are you trying to help? 2. What are you trying to achieve? 3. What is the logic underpinning your intervention? emotional learning curriculum for children in the primary school years that prevents the onset of emotional and behavioural problems (and indirectly getting behind in school work). An example of an early intervention is the Incredible Years parenting programme, which seeks to support parents of children at high risk of developing a conduct disorder, thus reducing its incidence. (Note how early means early in the 4. What is the evidence underpinning your intervention? stage of development of the problem, not always early in the child s life.) An example of a treatment-based approach is Functional Family Therapy, which 5. How will you communicate what the intervention is to a broad audience? involves treating young people who have already developed conduct disorders. Having made these important distinctions, you should seek a more fine-grained 1. Who are you trying to help? There are at least two things to consider as you define what group of children you are trying to help. The first is what stage of child development you are focusing on: pre-school (from antenatal to four or five years old), primary school years, secondary school or early adulthood? These four categories are crudely defined, and you might want to be more refined about your choice. description of your target group. If the intervention is for primary school children, is it for all children in that age-group or, say, 9-11 year-olds? If it is seeking to reduce anti-social behaviour among at risk adolescents, how is at risk defined do participants need to display certain risks, such as impulsivity or doing badly at school? If it is aiming to prevent suicide is it unsuitable for some young people for whom it will only make matters worse? Is it for boys and girls? Is it targeted at families who are financially hard-up, or all families? Answering such questions will minimise any ambiguity there might be about whom your intervention is for. 13

16 2. What are you trying to achieve? 3. What is the logic underpinning your intervention? There is no pre-determined list of outcomes, but it is helpful to focus on selected Even the most complicated of successful interventions will be underpinned by a developmental outcomes. These are ordinary landmarks in a child s development simple, clear and logical description of how the anticipated outcomes will be which, if not achieved, will likely affect a child well into adulthood. For example, if a achieved with the target population. This description is called a theory of change : child s reading is well behind by entry to secondary school, we know the negative what makes us think that the proposed intervention will produce the results we consequences can be long-lasting. If there is sufficient attachment in the relationship desire? Of course, it is not difficult to justify most ideas. Many proposed between mother and child such that the child can behave autonomously in the pre- interventions are simply an existing idea retrospectively fitted into a logical school years, there will likely be some positive benefit at least through childhood. sequence. To be useful, a theory of change must push the intervention designer to test the emerging ideas robustly. This critical thinking should be the first test of an An emphasis on a particular developmental outcome can help to keep the intervention long before the intervention ever takes place. intervention focused. Because outcomes are often linked, it is easy to get distracted by the possibility of improving a whole chain of outcomes. For example, improving There are essentially two steps to create your theory of change. First, you need to emotional and behavioural development in the primary school years may have a articulate a theory of the problem. Typically this begins with an outline of the risks knock-on impact on improving reading and writing, on the basis that happy, more that make the poor outcome you want to improve more likely. This list of risks may attentive students learn more! This is good of course, but such spin-off benefits are be drawn from experience, local evidence, national and international studies or, more likely when an intervention has a disciplined focus on achieving the outcomes possibly, some composite of the three. The task often extends to a description of any it is designed to achieve. Paradoxically, trying to achieve lots of outcomes makes it protective factors that ameliorate the impact of risks on child well-being. You are less likely that any will be achieved. The objective of keeping your focus precise is to likely to need experts to help you find and appraise the most appropriate research. increase your odds of doing one thing well (while giving you an outside chance in other areas). These connections can be tested for their logic. Is there really a connection between X and Y? Is the suggested connection intuitive, and does it ring true for practitioners Establishing what change you expect to see in the target outcomes should draw on and family members? These points of connection are generally referred to as chains previous research. It should be possible to estimate how much progress is possible of effects in a child s development. for the target group over a given period. To what degree have similar interventions improved relevant outcomes? Is there anything about your intervention or target The second step is to create your theory of change to propose activities that will group that leads you to expect more or less impact? You will need to consult experts prevent the risk from happening in the first place, reduce the impact of the risk, and the scientific literature to help determine this. The more precise you can be, the break its connection with another risk in the chain of effects, or boost the protective better, as it will give the design team and your backers confidence that your factors known to offset risks in some way. Your proposed activities might do all of intervention can achieve what you set out to achieve. these or only one or two. Essentially this is your theory of the solution. It also needs to be tested for its logic. 14

17 There will always be a tendency to allow enthusiasm for the proposed intervention risks, protective factors and outcomes between the target group and general or new ways of doing things to override the need for subjecting it to this kind of test. population of children. This should lead to a hypothesis about the extent to which But generally speaking, the greater the investment in these early design stages, the risk can be reduced, protective factors boosted and outcomes improved. A glance at more accurate the drawing of the chains of effects, and the more logical and the literature on effective interventions will remind you to maintain modest evidence-based the proposed intervention components, the more likely it is that the aspirations. proposed intervention will have its desired effect. Evidence used in the design and early implementation stages should be collated, 4. What is the evidence underpinning your intervention? summarised and made accessible. This will have several benefits. It will form a barometer of confidence for potential investors and users. The stronger the evidence Both steps in creating the theory of change for your intervention also need to draw base, the stronger will be the reason to think it may work. It will also help future on the best-available evidence about what negatively impacts on child outcomes and pioneers. Even the best-planned initiatives can sometimes fail. Even the most what works in improving them. effective interventions fall short of complete success: there is always room to do Our standards place a lot of stress on understanding the patterns of risk and protection that lead to poor outcomes, on the basis that reducing risk or boosting protection against that risk will lead to better outcomes. This kind of evidence, which better. Those wanting to know why something doesn t work, or seeking to improve on existing interventions, will be served by having access to all of the available evidence. essentially traces the potential causes of impairments to children s health and 5. How will you communicate what the intervention is to a broad development, demands some exploration of existing research that has focused on the audience? outcomes your intervention is seeking to change. The standards place a similar emphasis on research into what works. For most outcomes there will already be a body of knowledge indicating the kinds of things that are likely to achieve the desired change in outcomes for the chosen target group. For example, we know that certain types of parent skills training can improve parenting behaviour, which in turn can improve children s behaviour. We know what makes for good social-emotional teaching in schools, and what is less effective. We also know when mentoring works and when it doesn t, and what makes the difference. In many cases the research literature on these and similar topics is vast but there are helpful summaries, which you should consult. With good quality evidence it should be possible to inject precision into the equation about what matters and what works. There should be evidence on the difference in In the design phase there is a natural tendency to look to what will happen in the first months or years of an intervention. But if the intervention is to be sustained to spread and make a lasting difference to children s lives it is necessary to think longer-term. In initial tests, the intervention will most likely be delivered by those who have been involved in designing it, bringing to the mix all the enthusiasm and excitement often associated with a new venture. But longer term, the intervention will need to be delivered by people who were not involved in its design and who, far from being enthusiastic, may actually be hostile to the prospect of taking on something new. Three steps can be built into the design stage to give the intervention the best chance of long-term success. First, at the most basic level, designers need to provide the factual information commissioners need when making decisions. At a minimum, this 15

18 information includes: whom the innovation is for; what is delivered; how it is delivered; what kinds of staff resource it requires, and how it is deployed; how long the intervention lasts; where it should it take place; and how much it costs. This information should be well packaged, engaging and freely available. Second, developers can help to engage and motivate would-be users by attempting to re-create the emotional charge that produced the innovation. What was the driving force behind the design of the intervention? What individual stories or case studies led to the development of the idea? You might use these to help create an intrinsic demand or pull for the intervention. Third, the success of an intervention rests on both fidelity and versatility: it must be possible to repeat the key ingredients that make the intervention work while moulding the intervention to fit local contexts. So, a vital part of conveying an intervention to a broader audience is a clear exposition of what is core and therefore immutable, and what is peripheral and therefore adaptable. The key is to be clear about what can and cannot be changed, and why. It will be helpful if you specify which components do not influence the final outcome but can be adapted to allow service providers in other areas to make the innovation their own. As the next chapter shows, this information then needs to be translated into good documentation and training materials that are accessible and meaningful to people working in contexts quite different from that in which the intervention was originally delivered. Well-prepared manuals will retain their vitality, becoming a source of useful information for managers and practitioners even when the intervention becomes a routine part of their work. 16

19 Planning for implementation: how to improve system readiness 3

20 Chapter 3: Section 1 What is system readiness? 1. Reaching the right people targeting, recruitment and retention There are explicit processes for ensuring that the intervention gets to the right people. The most effective intervention for improving the behaviour of pre-school children will have little chance of widespread impact if it is delivered to primary school pupils. Similarly, an intervention designed for children with a conduct disorder is likely to be of limited value if offered to children with minor emotional problems. Having gone to the trouble of getting focus into the intervention, you need to ensure that it reaches the children for whom it is intended. This might be as simple as being If a successful intervention is to have a positive impact at scale, it needs to be implemented by absolutely clear about the conditions in which the intervention can be delivered. Or people other than those who designed it in other words, by regular staff in regular services. it may require using standardised screening instruments to select those children or Put another way, an intervention is of limited use if it can only be delivered by a small and families eligible for the proposed support. It may also involve setting up processes select number of highly-trained people in one place. So the second dimension of the standards for connecting participants to the intervention, such as referral pathways for partner is concerned with whether the intervention can be implemented within public service systems service agencies, and developing strategies for recruitment and retention to help - such as the education, health, youth justice and social care systems. This chapter describes eligible participants access the intervention initially and then continue accessing it. the criteria in the standards of evidence used to assess system readiness and then looks at how it can be improved for a given intervention. There are four key aspects to system readiness: 1. Reaching the right people targeting, recruitment and retention 2.Supporting the people delivering the intervention 3. Getting the financial and human resources in place 2. Supporting the people delivering the intervention There are one or more manuals detailing the intervention. Most interventions will require that specific strategies are followed by a practitioner, whether it is a teacher, youth justice expert, volunteer, psychologist or social worker. The people managing, delivering and monitoring the intervention have to know what is expected of them. This part of the standards therefore focuses on the 4. Capacity for scale different types of support that should be available to practitioners delivering the intervention. Generally the practitioner will have been trained and know what is expected of them. But when they are enmeshed in their day-to-day work they will benefit from 18

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